Endometriose profunda: achados clínicos e epidemiológicos de mulheres diagnosticadas segundo critérios do international deep endometriosis analysis group (IDEA)
DOI:
https://doi.org/10.36311/jhgd.v32.13312Palavras-chave:
endometriose, epidemiologia, ultrassonografia, dismenorreia, dor pélvica, infertilidadeResumo
Introdução: Endometriose ocorre quando o tecido semelhante ao endométrio acomete o peritônio, podendo infiltrar estruturas e órgãos como o intestino, o ureter, a bexiga ou a vagina e geralmente está acompanhado de processo inflamatório. Estima-se que a doença acometa 6 a 10% das mulheres em idade reprodutiva e mais de 50% das mulheres inférteis. Os dados clínicos e epidemiológicos das pacientes com EP disponíveis na literatura são provenientes de estudos cujas amostras foram selecionadas por cirurgia, portanto passíveis de vieses de seleção. A ultrassonografia pélvica endovaginal com preparo intestinal (USGTVP) tem valores de especificidade e sensibilidade elevados.
Objetivo: analisar o perfil clínico e epidemiológico das pacientes portadoras de EP diagnosticadas através da USGTVP.
Método: estudo transversal, que analisou 227 pacientes com diagnóstico ultrassonográfico de endometriose profunda.
Resultados: infertilidade acometeu 43,8% das mulheres. Sintomas álgicos considerados como moderado ou grave (escala visual analógica, EVA, >3) apresentaram respectivamente a seguinte prevalência e valores médios na escala de EVA: dismenorreia em 84,7% (6,9), dispareunia em 69,1%, (4,2) disquezia menstrual em 60,7% (4,3) e disúria menstrual em 35,7% das pacientes. Antecedente de múltiplas cirurgias ocorreu em 10,4 % e apenas 6,8 % das portadoras haviam realizado fisioterapia para assoalho pélvico.
Conclusão: a população portadora de EP apresentou alta prevalência de infertilidade e sintomas álgicos, achados que refletem o impacto social na qualidade de vida e no planejamento familiar dessas mulheres. A alta frequência de antecedentes de múltiplas abordagens cirúrgicas e a baixa incidência de antecedente de realização de fisioterapia pélvica na população com EP, contrariando as recomendações de tratamento ideal atualmente já estabelecidas, sinalizam a dificuldade de acesso das portadoras a centros especializados.
Referências
Sampson, J. A. Peritoneal endometriosis due to premenstrual dissemination of endometrial tissue into the peritoneal cavity. Am. J. Obstet. Gynecol.14, 422–469 (1927).
Giudice, L. C. & Kao, L. C. Endometriosis. Lancet364, 1789–1799 (2004).
Kuznetsov L, Dworzynski K, Davies M, Overton C. Diagnosis and management of endometriosis: Summary of NICE guidance. BMJ (Online). 2017; 358:1–5.
Fauconnier A, Chapron C. Endometriosis and pelvic pain: Epidemiological evidence of the relationship and implications. Human Reproduction Update. 2005; 11(6): 595–606.
Giudice, L. C., & Ph, D. (2010). Endometriosis. N Engl J Med 2010; 362: 2389-98.
CHAPRON, C. et al. Rethinking mechanisms, diagnosis and management of endometriosis. Nature Reviews Endocrinology, v.15, n.11, p.666-682, 2019.
MABROUK, M. et al. Painful Love: Superficial Dyspareunia and Three Dimensional Transperineal Ultrasound Evaluation of Pelvic Floor Muscle in Women with Endometriosis. Journal of Sex & Marital Therapy, v.46, n.2, p.187-196, 2020.
Bazot M, Thomassin I, Hourani R, Cortez A, Darai E. Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis. Ultrasound Obstet Gynecol 2004; 24(2): 180–185.
DESLANDES, A. et al. (2020). Current Status of Transvaginal Ultrasound Accuracy in the Diagnosis of Deep Infiltrating Endometriosis Before Surgery. Journal of Ultrasound in Medicine, 1–14.
ABRAO, M. S. et al. Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum Reprod, v.22, n.12, p. 3092-3097, 2007
Goncalves, M. O. D. C., Podgaec, S., Dias, J. A., Gonzalez, M., & Abrao, M. S. (2010). Transvaginal ultrasonography with bowel preparation is able to predict the number of lesions and rectosigmoid layers affected in cases of deep endometriosis, defining surgical strategy. Human Reproduction, 25(3), 665–671.
Chamié, L. P., Pereira, R. M. A., Zanatta, A., & Serafini, P. C. (2010). Transvaginal US after Bowel Preparation for Deeply Infiltrating Endometriosis: Protocol, Imaging Appearances, and Laparoscopic Correlation. RadioGraphics, 30(5), 1235–1249.
Fauconnier A, Chapron C, Dubuisson JB, Vieira M, Dousset B, Bréart G. Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis. Fertility and Sterility. 2002; 78(4): 719–26.
CHAPRON, C. et al. (2001). Does deep endometriosis infiltrating the uterosacral ligaments present an asymmetric lateral distribution? British Journal of Obstetrics and Gynaecology, 108(10), 1021–1024.
Chapron C, Fauconnier A, Vieira M, Barakat H, Dousset B, Pansini V, et al. Anatomical distribution of deeply infiltrating endometriosis: Surgical implications and proposition for a classification. Human Reproduction. 2003; 18(1): 157–61.
Chapron C, Chopin N, Borghese B, Foulot H, Dousset B, Vacher-Lavenu MC, et al. Deeply infiltrating endometriosis: Pathogenetic implications of the anatomical distribution. Human Reproduction. 2006; 21(7): 1839–45.
TISSOT, M. et al. Clinical presentation of endometriosis identified at interval laparoscopic tubal sterilization: Prospective series of 465 cases. Journal of Gynecology Obstetrics and Human Reproduction, 46(8), 647–650, 2017.
BAZOT, M, I. et al. Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis. Ultrasound in Obstetrics and Gynecology, v.24, n.2, p.180-185, 2004.
Martinez, J. E., Centola Grassi, D., & Marques, L. G. (2011). Análise da aplicabilidade de três instrumentos de avaliação de dor em distintas unidades de atendimento: ambulatório, enfermaria e urgência. In Rev Bras Reumatol (Vol. 51, Issue 4).
Haefeli, M., & Elfering, A. (2006). Pain assessment. In European Spine Journal (Vol. 15, Issue SUPPL. 1).
Chamié, L. P. (2019). Ultrasound evaluation of deeply infiltrative endometriosis: technique and interpretation. Abdominal Radiology.
GUERRIERO, S. et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound in Obstetrics & Gynecology, v. 48, n.3, p. 318-332, 2016.
Ros, C., Guirior, C., Mension, E., Rius, M., Valdés-Bango, M., Tortajada, M., Matas, I., Martínez-Zamora, M. Á., Gracia, M., & Carmona, F. (2021). Transvaginal ultrasound for the diagnosis of endometriosis in the uterosacral ligaments, torus uterinus and posterior vaginal fornix: a prospective study. Ultrasound in Obstetrics & Gynecology.
Leonardi, M., Martins, W. P., Espada, M., Arianayagam, M., &Condous, G. (2020). Proposed technique to visualize and classify uterosacral ligament deep endometriosis with and without infiltration into parametrium or torus uterinus. In Ultrasound in Obstetrics and Gynecology (Vol. 55, Issue 1, pp. 137–139). John Wiley and Sons Ltd.
BAZOT, M. et al. Diagnostic accuracy of physical examination, transvaginal sonography, ectal endoscopic sonography, and magnetic resonance imaging to diagnoses deep infiltrating endometriosis. Fertility and Sterility, v. 92, n.1, p.1825-1833, 2009.
MORGAN-ORTIZ, F. et al. (2018). Clinical characteristics and location of lesions in patients with deep infiltrating endometriosis using the revised Enzian classification. Journal of the Turkish German Gynecology Association, 20(3), 133–137.
Dovey, S., &Sanfilippo, J. (2010). Endometriosis and the adolescent. ClinicalObstetricsandGynecology, 53(2), 420–428.
Bazot, M., Lafont, C., Rouzier, R., Roseau, G., Thomassin-Naggara, I., Daraï, E. (2008). Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis.
HUDELIST, G. et al. Diagnostic delay for endometriosis in Austria and Germany: Causes and possible consequences. Human Reproduction, v.27, n.12, p.3412-3416, 2012.
GHAI, V. et al. (2020). Diagnostic delay for superficial and deep endometriosis in the United Kingdom. Journal of Obstetrics and Gynaecology, 40(1), 83–89.
NNOAHAM, K. E. et al. (2011). Impact of endometriosis on quality of life and work productivity: A multicenter study across ten countries. Fertility and Sterility, 96(2).
CHAPRON C. et al. Oral contraceptives (OC) and endometriosis: the past use of OC for treating severe primary dysmenorrheal appears as a marker associated with endometriosis, especially deep infiltrating endometriosis. HumReprod 2011; 26:2028e35.
Vercellini, P., Eskenazi, B., Consonni, D., Somigliana, E., Parazzini, F., Abbiati, A., & Fedele, L. (2010). Oral contraceptives and risk of endometriosis : a systematic review and meta-analysis. 00(0), 159–170.
PILLET, M. C. L.et al. (2014). A clinical score can predict associated deep infiltrating endometriosis before surgery for an endometrioma. 0(0), 1–11.
YONG, P. J. et al. (2015). Concurrent deep-superficial dyspareunia: Prevalence, associations and outcomes in a multidisciplinary vulvodynia program. The Journal of Sexual Medicine,12 (1), 219–227.
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